Lehigh Valley Health Experts Predict What's Around The Corner

January 02, 1990|by ROSA SALTER, The Morning Call

As the world rounds the curve into the 1990s and the end of the 20th century, we asked several top local health experts to turn away from their microscopes and look into their crystal balls for what they see coming in their specialties. Here is some of what they had to say:

Dr. Jeffrey Jahre, a specialist in infectious diseases at St. Luke's Hospital, Bethlehem, says the trend for AIDS in the '90s will be both bad and good, with fewer homosexuals and tranfused people affected but more cases among women, children and low-income people.

"There are a few things which almost everyone agrees on. No. 1 is that the number of AIDS cases will rise. By the end of 1992, we will have 365,000 cumulative cases of AIDS from the beginning of the epidemic, and that's to be contrasted with what we have now, which is about 100,000. What we are talking about is a tripling in the number of cases in three years. Looking at 1992, we'll have as many new cases in that year as we've had now cumulatively.

"The second thing that everyone agrees on is that with the increased number of cases, the costs are going to rise. The estimated costs will be between $5 and $15 billion . . ..

"The other thing we're beginning to see now is, with better methods of treating and delaying or preventing the disease, we have this disease going into a more chronic disease picture -- patients are living longer and requiring more prolonged treatment. The costs of that type of treatment will go up, and much of the focus will shift from inpatient care to out-of-hospital care.

"Up to this point, the therapy has all been wrapped around one drug, azidothymidine, AZT. In the next five years, there are at least two more drugs that will enter the arena, DDI and CD-4 . . . They could turn out to be (helpful) or they could turn out to be nothings, but they're in the pipeline.

"As for a vaccine, there's good expectation now, and I couldn't say that 10 years ago --that in the next 10 years, we will do that. There's been a lot of work on the makeup of this virus.

"I've always said the Lehigh Valley represents the nation as a whole -- these trends will occur here. There's no reason to expect they won't."

* * *

Dr. Greg Lang of Allentown, reproductive medicine specialist, says that by the '90s, infertile couples will find a shortened pipeline for treatment -- and more options.

"Actually, there are probably four major areas where things are going to significantly change. The first has to do with new drugs . . . By the '90s, there will be a nasal preparation, a spray that you squirt in your nose (to treat infertility) . . . It will revolutionize gynecology because it's very simple.

"From a surgical point of view . . . laparoscopy and pelviscopy will replace most infertility surgery. If you can't do it through a laparoscope, you'll forget the surgery and just do test-tube babies . . . I've heard that if IVF (in vitro fertilization) becomes just a little more efficient, and I have no doubt that it will, there will come a time when you walk into the doctor's office and you're having trouble getting pregnant for any reason except that you're not ovulating, it will all be treatable with IVF.

"The other place of significant revolution will have to do with micromanipulation, (such as) zona drilling or zona peeling. It's where you take small amounts of sperm and inject it (under a microscope) into an egg . . . The normal person is also going to be freezing embryos and eggs. . . . You can bank eggs, just like you do for sperm . . . The Japanese have even been able to take immature eggs and mature them in culture and fertilize them and create kids. . . . This is cutting edge kind of stuff, but it's already happening."

* * *

Gary Gurian is director of the Allen-town Health Bureau and an outspoken advocate on public health issues, disease prevention and health policy. He predicts more public health activism in the 1990s.

"There are two things I see coming within the next decade.

"One is a move toward a national-ized system of health care, similar to what they have in Canada.

"The other is the environment as it relates to our health as well as our qual-ity of life.

"This will range from more atten-tion to the chemicals we use in our daily lives to the disposal of our everyday household and commercial waste.

"The reason we'll be able to do all these things is, I'll be honest with you, due to the events in Eastern Europe, we'll be spending much less money on that black hole known as defense.

"What we hope to do here in Allen-town . . . is have a primary health care center, a community health center, that provides the highest-quality basic health care services for people regardless of their ability to pay . . .